“How much lymph can a lymph pump pump if a lymph pump can pump lymph?”: —Norman Gevitz, PhD1

doi:10.7556/jaoa.2012.112.7.408

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“How much lymph can a lymph pump pump if a lymph pump can pump lymph?”

—Norman Gevitz, PhD¹

Published/Copyright: July 1, 2012

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From the journal Journal of Osteopathic Medicine Volume 112 Issue 7

Schander A, Downey HF, Hodge LM. Lymphatic pump manipulation mobilizes inflammatory mediators into lymphatic circulation. Exp Biol Med.2012;237(1):58-63.

As a challenge to osteopathic manipulative treatment (OMT) researchers, Norman Gevitz, PhD, has suggested that lymphatic pump techniques (LPTs) are high data-yield applications.¹ In recent clinical trials, LPTs have shown benefits for hospitalized patients with pneumonia.² However, the greatest advances in demonstrating the effects of LPT have been made in studies of animal models. The breakthrough study in this field, published by Knott et al³ in JAOA—The Journal of the American Osteopathic Association in 2005, showed that lymph flow in dogs was increased by LPT. Subsequent research in the same laboratories, at the University of North Texas Health Science Center in Fort Worth, has shown that LPT in dogs increases leukocyte count in thoracic duct lymph,⁴ and that a primary source of these leukocytes is gut-associated lymphatic tissue.⁵

The study by Schander et al—the most recent publication in this line of research—measured a number of inflammatory mediators in dogs before, during, and after LPT. Twelve unconscious, healthy, mongrel dogs were used in this study. Six of the dogs had catheters inserted into the thoracic lymphatic duct (TLD), and the other 6 dogs had catheters inserted into the mesenteric lymphatic duct (MLD). One hour after cannulation, lymph was collected during a 4-minute pre-LPT period, during a 4-minute LPT period, and during a 10-minute post-LPT period. The dogs were in the right lateral recumbent position during LPT, and the hands of the operator (an osteopathic physician) were placed bilaterally just below the costodiaphragmatic junction. Manual force was directed medially and cranially to compress and then release the abdomen at a rate of about 1 compression per second.

The outcome measures were lymph flow; cytokine/chemokine flux (ie, the rate of flow multiplied by the concentration of the cytokine or chemokine, as a way to describe the distribution of these substances in circulation); and the concentrations of proinflammatory cytokines and chemokines—including interleukin 6 (IL-6), IL-8, IL-10, monocyte chemotactic protein-1 (MCP-1), and keratinocyte chemoattractant (KC)—for both the TLD and MLD collections. In addition, superoxide dismutase and nitrotyrosine were collected for the TLD.

The results showed that, as indicated in previous studies, LPT transiently increased the flow of lymph during the active LPT procedure for both the dogs that had catheters inserted into the TLD and the dogs that had catheters inserted into the MLD. Although there was a general increase in the concentrations of cytokines and chemokines during the LPT procedure, compared with the pre- and post-LPT periods, only the MCP-1 level was increased to a statistically significant amount in the TLD dogs. In the MLD dogs, LPT was associated with a statistically significant increase in IL-8 and MCP-1. However, when cytokine/chemokine flux was measured, IL-6, IL-8, IL-10, MCP-1, and KC were found to be increased to statistically significant levels by LPT in both the TLD and MLD dogs. Furthermore, in the TLD dogs, superoxide dismutase and nitrotyrosine flux were increased to statistically significant levels by LPT.

As a “treatment provider” in earlier studies conducted at the University of North Texas Health Science Center,^4,5 I perceived dogs' responses to LPT to be very much like those of humans, lending credibility to the generalizability of the animal data to the human condition. Immune system functions in dogs and humans are similar enough to expect that, in response to LPT, levels of cytokines and chemokines in humans would respond similarly to the canine levels of cytokines and chemokines reported by Schander et al. However, advances in technology, such as lymphatic flow imagery, are needed to measure these types of responses to LPT in humans.

The authors state, “LPT may enhance protection against infection by increasing mesenteric-derived inflammatory mediators in circulation, enabling the re-distribution of these mediators to other tissues.” The single caveat is that the LPT used in the Schander et al study was performed on healthy dogs, and the impact of LPT on dogs or humans with identifiable disorders remains to be determined.

For researchers who work according to the osteopathic tenet that the body is self-regulatory and self-healing, this study, as well as the general line of research it represents, is an excellent example of how OMT supports this tenet. In my own clinical practice, I have often described this line of research when treating a patient who had an infection or who was in need of immune system enhancement, as a way of encouraging the patient's bodily response and receptivity to OMT, including LPT.—H.H.K.

“The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the
renewed interest in manual medicine internationally, especially in Europe.
To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (mseffinger@westernu.edu), or Editorial Board Member Hollis H. King, DO, PhD (hollis.king@fammedwisc.edu).

References

1 Gevitz N . Center or periphery? the future of osteopathic principles and practices. J Am Osteopath Assoc.2006;106(3):121-129.Search in Google Scholar

2 Noll DR Degenhardt BF Morley TF et al. . Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2.10.1186/1750-4732-4-2Search in Google Scholar PubMed PubMed Central

3 Knott EM Tune JD Stoll ST Downey HF . Increased lymphatic flow in the thoracic duct during manipulative intervention. J Am Osteopath Assoc.2005;105(10):447-456.Search in Google Scholar

4 Hodge LM King HH Williams AG et al. . Abdominal lymphatic pump treatment increases leukocyte count and flux in thoracic duct lymph. Lymphat Res Biol.2007;5(2):127-133.10.1089/lrb.2007.1001Search in Google Scholar PubMed

5 Hodge LM Bearden MK Schander A et al. . Lymphatic pump treatment mobilizes leukocytes from the gut associated lymphoid tissue into lymph. Lymphat Res Biol.2010;8(2):103-110.10.1089/lrb.2009.0011Search in Google Scholar PubMed PubMed Central

Published Online: 2012-07-01

Published in Print: 2012-07-01

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